Three dimension printing talar prostheses for total replacement in talar necrosis and collapse

Abstract

Background Reconstructing bone structures and stabilizing adjacent joints are clinical challenges in treating talar necrosis and collapse (TNC). 3D printing technology has been demonstrated to improve the accuracy of talar replacement. This study aimed to evaluate anatomical talar replacement and the clinical results. Methods Nine patients with TNC were enrolled between 2016 and 2020. The prosthetic shape and size were designed by CT post-processing and mirror symmetry technology. The clinical outcomes included radiographic parameters of the forefoot, hindfoot, and ankle alignment, ankle activity, recurrent pain, and peri-operative complications. Results After a mean follow-up of 23.17 ± 6.65 months, degenerative arthritis and prosthetic dislocation and other complications were not observed on plain radiographs. Each 3D-printed talar prosthesis was placed in the original anatomical position. The parameters which have significant changes pre-operative and post-operative are as follows: talar height, 27.59 ± 5.99 mm and 34.56 ± 3.54 mm (95% CI − 13.05 to − 0.87, t = 2.94, P = 0.032) and Meary’s angle, 11.73 ± 4.79° and 4.45 ± 1.82° (95% CI 1.29~22.44, t = 2.89, P = 0.034). The AOFAS hindfoot score improved from 26.33 ± 6.62 to 79.67 ± 3.14 at the final follow-up (95% CI 43.36~63.30, t = 13.75, P = 0.000). The VAS score decreased from 6.33 ± 1.03 to 0.83 ± 0.75 (95% CI 4.40~6.60, t = 12.84, P = 0.000). The post-operative satisfaction scores regarding pain relief, activities of daily living, and return to recreational activities were good to excellent, and the change of activity range was statistically significant. Conclusions The 3D printing patient-specific total talar prostheses allowed anatomical reconstruction in TNC. This novel treatment with 3D-printed prostheses could serve as a reliable patient-specific alternative in TNC.

WITHDRAWN: Establishment of a Finite Element Model and Biomechanical Analysis of Different Fixation Methods for Total Talar Prosthesis Replacement

“…For the prosthesis-bone interface needing screw xation, a special coating is often used to achieve the biomechanical effect of bone ingrowth. Professor Tang Kanglai's team conducted a series of studies on this topic and has made clinical progress [27][28]. The operation is similar to fusion surgery.…”

WITHDRAWN: Establishment of a Finite Element Model and Biomechanical Analysis of Different Fixation Methods for Total Talar Prosthesis Replacement

“…For prosthesis-bone interfaces needing screw xation, a special coating is often used to achieve the biomechanical effect of bone ingrowth. Professor Tang Kanglai conducted a series of studies on this topic and made clinical progress [27,28]. The operation is similar to fusion surgery.…”

Total Talar Replacement With Custom-Made Vitallium Prosthesis for Talar Avascular Necrosis

“…( Angthong, 2014 ; Taniguchi and Tanaka, 2019 ) Due to the unique anatomic form of the talus, the vital element for a successful prosthetic TTR is the congruency of the custom-made implant with the adjacent joints. ( Mu et al, 2021 ) Despite the rapid development of TTR prostheses however, full reconstruction of the anatomic features of a native talus—which would optimally stabilize and maintain normal ankle function—remains a challenge. ( Ando et al, 2016 ) Three-dimensional (3D) printing technology integrated with computed tomography (CT) imaging and computer-aided design has now been widely used in surgical planning and custom-made implant design, to achieve anatomic accuracy in talar prosthetic design and production.…”

“…( Ando et al, 2016 ) Three-dimensional (3D) printing technology integrated with computed tomography (CT) imaging and computer-aided design has now been widely used in surgical planning and custom-made implant design, to achieve anatomic accuracy in talar prosthetic design and production. ( Akoh et al, 2020 ; Mu et al, 2021 ) 3D printing has shown tremendous potential for the design and production of refined structures with irregular shapes and free surfaces such as the talar body. Thus, the utilization of 3D printing technology in conjunction with TTR may be a promising way for surgeons to provide more personalized, anatomically accurate, and above all more durable surgical solutions with better long-term prognoses.…”